Systolic and diastolic murmurs in a patient with valvar aortic stenosis

Phonocardiogram recorded at the right upper sternal border in a patient with bicuspid aortic valve, mild-moderate AS (peak systolic Doppler gradient 35 to 40 mmHg from the apical view) and moderate AR. There is a systolic ejection murmur of AS and diastolic blowing murmur of AR.